Superficial Temporal Recipient Vessels in Microvascular Orbit and Scalp Reconstruction of Oncologic Defects

ABSTRACT

The superficial temporal artery and vein (STA/V) are often considered suboptimal recipient vessels due to anecdotal reports that they are unreliable and prone to spasm. This is unfortunate, as their position greatly facilitates reconstruction of the scalp and orbit. We present our experience with 28 patients who underwent microvascular craniofacial reconstruction of oncological defects using the STA/V as recipients over a 4-year period at a single institution. Rates of vessel thrombosis, total flap loss, and partial flap loss were not significantly different from 282 flaps anastomosed to neck vessels. With knowledge of the anatomy and proper technique, the STA/V are reliable and available in most patients and can facilitate microvascular orbit and scalp reconstruction. The proximity they offer allows more flexibility in flap pedicle length requirement and avoids the use of vein grafts. Caution should be exercised if there is a history of radiation therapy.

KEYWORDS

Superficial temporal vessels - microsurgery - head and neck reconstruction - orbital reconstruction - scalp reconstruction

REFERENCES

• 1 Newell D W, Vilela M D. Superficial temporal artery to middle cerebral artery bypass.  Neurosurgery. 2004;  54 1441-1448
• 2 Yoshioka N, Tominaga S, Suzuki Y et al.. Vascularized omental graft to brain surface in ischemic cerebrovascular disease.  Microsurgery. 1995;  16 455-462
• 3 Yoshioka N, Tominaga S. Cerebral revascularization by omental free flap using contralateral superficial temporal vessels as recipient vessels: case report.  Surg Neurol. 1997;  47 460-465
• 4 Onishi K, Maruyama Y, Kayashi A, Inami K. Repair of scalp defect using a superficial temporal fascia pedicle VY advancement scalp flap.  Br J Plast Surg. 2005;  58 676-680
• 5 Ali F, Halim A S, Najihah S Z, Ibrahim M, Abdullah J. Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child.  J Craniomaxillofac Surg.. 2005;  33 326-330
• 6 Brent B, Upton J, Acland R D et al.. Experience with the temporoparietal fascial free flap.  Plast Reconstr Surg. 1985;  76 177-188
• 7 Sakai S, Soeda S, Ishii Y. Avulsion of the scalp: which one is the best artery for anastomosis?.  Ann Plast Surg. 1990;  24 350-353
• 8 Alpert B S, Buncke H J, Mathes S J. Surgical treatment of the totally avulsed scalp.  Clin Plast Surg. 1982;  9 145-159
• 9 Siebert J W, Anson G, Longaker M T. Microsurgical correction of facial asymmetry in 60 consecutive cases.  Plast Reconstr Surg. 1996;  97 354-363
• 10 Hansen S L, Foster R D, Dosanjh A S et al.. Superficial temporal artery and vein as recipient vessels for facial and scalp microsurgical reconstruction.  Plast Reconstr Surg. 2007;  120 1879-1884
• 11 Ueda K, Harii K, Nakatsuka T, Asato H, Yamada A. Comparison of end-to-end and end-to-side venous anastomosis in free-tissue transfer following resection of head and neck tumors.  Microsurgery. 1996;  17 146-149
• 12 Yamamoto Y, Nohira K, Kuwahara H et al.. Superiority of end-to-side anastomosis with the internal jugular vein: the experience of 80 cases in head and neck microsurgical reconstruction.  Br J Plast Surg. 1999;  52 88-91
• 13 DeLacure M D, Kuriakose A, Spies A L. Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 1999;  125 869-872
• 14 Katou F, Echigo S, Masatake I et al.. Reliability of internal jugular vein in oral microvascular reconstruction.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;  86 529-533
• 15 Graham B B, Varvares M A. End-to-side venous anastomosis with the internal jugular vein stump: a preliminary report.  Head Neck. 2004;  26 537-540
• 16 Chalian A A, Anderson T D, Weinstein G S, Weber R S. Internal jugular vein versus external jugular vein anastomosis: implications for successful free tissue transfer.  Head Neck. 2001;  23 475-478
• 17 Aston S J, Beasley R W, Thorne C HM. Grabb and Smith's Plastic Surgery. Philadelphia; Lippincott-Raven 1997
• 18 Yazar S, Wei F C, Chen H C et al.. Selection of recipient vessels in double free flap reconstruction of composite head and neck defects.  Plast Reconstr Surg. 2005;  115 1553-1561
• 19 Longaker M T, Flynn A, Siebert J W. Microsurgical correction of bilateral facial contour deformities.  Plast Reconstr Surg. 1996;  98 951-957
• 20 Nahabedian M Y, Singh N, Deune E G, Silverman R, Tufaro A P. Recipient vessel analysis for microvascular reconstruction of the head and neck.  Ann Plast Surg. 2004;  52 148-155
• 21 McCombe D, Donato R, Hofer S, Morrison W. Free flaps in the treatment of locally advanced malignancy of the scalp and forehead.  Ann Plast Surg. 2002;  48 600-606